Overcoming challenges to achieving meaningful use: insights from hospitals that successfully received Centers for Medicare and Medicaid Services payments in 2011

Objective In an effort to understand better the federal electronic health record (EHR) incentive programme's challenges, this study compared hospitals that did and did not receive meaningful use (MU) payments in the programme's first year based on the challenges they anticipated a year before. Materials and Methods This cross-sectional study used 2010 American Hospital Association survey data and 2011 Centers for Medicare and Medicaid Services data that identify hospitals receiving MU payments. Multivariate regression analysis assessed differences in 2010 anticipated challenges to MU for hospitals that were successful in earning 2011 MU payment compared to hospitals that intended to participate in the programme but were not yet successful. Results The study sample consisted of 2475 hospitals, 313 of which received MU payments in 2011. Controlling for standard hospital characteristics, hospitals that reported the computerized provider order entry (CPOE) MU criterion as a primary challenge were 18% less likely to receive a 2011 MU payment compared to hospitals that reported other criteria as primary challenges. Discussion CPOE was the main challenge among hospitals that failed to achieve MU in the first year of the programme. In order to maximize the incentive programme's effectiveness, policymakers, healthcare organizations, and EHR vendors may benefit from increased attention to hospitals’ challenges with CPOE. Conclusion As the EHR incentive programme matures, policymakers and other stakeholders should consider strategies that maintain the critical elements of MU while adequately supporting hospitals that desire to become MU but are impeded by specific technological, cultural, and organizational adoption and use challenges

A systematic literature review on safe health information technology use behaviour

The implementation of health information technology (IT) is one of the strategy to improve patient safety due to medical errors. Nevertheless, inappropriate use of health IT may have serious consequences to the quality of care and patient safety. Most of the previous studies have been focused on the sociotechnical factors contributed to health IT related errors. Little focus has been given on the use behavior that influence the safety of health IT adoption. In order to address this gap, this study investigates the use behavior that influence the safety of health IT adoption. Systematic literature review was conducted to identify articles pertinent to safety of health IT. Science Direct, Medline, EMBASE, and CINAHL database were searched for reviews relevance articles. A total of 23 full articles were reviewed to extract use behavior that influence the safety of health IT adoption. Workarounds, adhere to procedure, vigilant action, and copy and paste behavior were discerned as the significance use behavior that influence health IT safety adoption. This study may be of significance in providing useful information on how to safely practice health IT adoption

Usability Evaluation of a Computerized Physician Order Entry for Medication Ordering

Despite CPOE (Computerized Physician Order Entry) systems’ potential to enhance patient safety by reducing medication errors, recent studies have cast some doubts on their role in error reduction. CPOE systems with poorly designed interfaces have proven to cause users dissatisfaction and to introduce new kind of errors in the ordering process, suggesting a threat instead of an enhancement of patient safety. The main objective of this study is to identify usability problems related to a CPOE medication system’s design and determining their severities. Two experts completed a cognitive walkthrough (CW) of an ordering task based on a clinical scenario for ordering the consolidation phase of chemotherapy for a leukemic patient. Fifty five usability problems were found and classified into eleven categories. CW identified cosmetic to catastrophic problems leading to inefficient use of the CPOE system and potentially resulting in users’ confusion, longer ordering duration, and medication errors. The complexity of the CPOE design, its rigidness and lack of user guidance suggests the necessity to redesign the current user interface in order to match clinicians’ ordering behaviors and to fully support them in the medication ordering process

A Clinician’s Report of the Unintended Consequences of Electronic Health Records

Electronic health records (EHRs) are complex. Clinicians must interact with patient data, order entry, decision support, reporting services, messaging programs, administrative data, and many other services. These services require user input and decision making, known as user interactions, between clinician and the EHR. EHRs have features designed to facilitate users’ interactions, such as alerts, reminders, keyboard shortcuts, and mouse click menus. These features can lead to unintended consequences, which combine with user interactions, thus making the EHR complicated and difficult to use. Awareness of user interactions and the unintended consequences will improve EHR design and lead to greater clinician acceptance of EHRs

The Two Sides of the Innovation Coin

With the use of the Stakeholder Theory and the Diffusion of Innovation Theory, a Model for Analysis of the Consequences of IT Innovation Adoption was developed, addressing both positive and negative sides of innovation consequences. The Model has been validated in interviews with PhDs specializing in the field, then applied to the case of Open Data adoption by the Federal District Government of Brazil. In the empirical study, 95 consequences for various stakeholders were categorized. The study’s synthesis can be viewed in a single image that reveals the similar and conflicting understandings of the different innovation stakeholders, and can be used as an innovation management tool: the Map of Consequences of Innovations Adoption

STAT-HI: A Socio-Technical Assessment Tool for Health Informatics Implementations

This paper proposes a socio-technical assessment tool (STAT-HI) for health informatics implementations. We explore why even projects allegedly using sound methodologies repeatedly fail to give adequate attention to socio-technical issues, and we present an initial draft of a structured assessment tool for health informatics implementation that encapsulates socio-technical good practice. Further work is proposed to enrich and validate the proposed instrument. This proposal was presented for discussion at a meeting of the UK Faculty of Health Informatics in December 2009

CPOE System Design Aspects and Their Qualitative Effect on Usability

Although many studies have discussed the benefits of Computerized Provider Order Entry (CPOE) systems, their configuration can have a great impact on clinicians’ adoption of these systems. Poorly designed CPOE systems can lead to usability problems, users’ dissatisfaction and may disrupt normal flow of clinical activities. This paper reports on a literature review focused on the identification of CPOE medication systems’ design aspects that impact CPOE systems’ usability and create opportunities for medication errors. Our review is based on a systematic literature search in PubMed, EMBASE and Ovid MEDLINE for relevant publications from 1986-2006. We categorized the design aspects extracted from relevant publications into six different groups: 1) timing of alerts, 2) log in/out procedures, 3) pick lists and drop down menus, 4) clues and guidelines, 5) documentation and data entry options, and 6) screen display and layout. Our review shows that the manner in which a CPOE system is configured can have a high impact on ease of system use, task behavior of clinicians in ordering drugs, and medication errors. Characterization of consequences associated with certain CPOE design aspects provides insight into how CPOE system designs can be improved to enhance physicians’ adoption of these systems and their success. Recommendations are provided to enable CPOE system designers to create CPOE systems that are not only more user friendly and efficient but safer

Primary Care Physicians' Experience with Electronic Medical Records: Barriers to Implementation in a Fee-for-Service Environment

Our aging population has exacerbated strong and divergent trends between health human resource supply and demand. One way to mitigate future inequities is through the adoption of health information technology (HIT). Our previous research showed a number of risks and mitigating factors which affected HIT implementation success. We confirmed these findings through semistructured interviews with nine Alberta clinics. Sociotechnical factors significantly affected physicians' implementation success. Physicians reported that the time constraints limited their willingness to investigate, procure, and implement an EMR. The combination of antiquated exam room design, complex HIT user interfaces, insufficient physician computer skills, and the urgency in patient encounters precipitated by a fee-for-service remuneration model and long waitlists compromised the quantity, if not the quality, of the information exchange. Alternative remuneration and access to services plans might be considered to drive prudent behavior during physician office system implementation

Organization-wide adoption of computerized provider order entry systems: a study based on diffusion of innovations theory

Background: Computerized provider order entry (CPOE) systems have been introduced to reduce medication errors, increase safety, improve work-flow efficiency, and increase medical service quality at the moment of prescription. Making the impact of CPOE systems more observable may facilitate their adoption by users. We set out to examine factors associated with the adoption of a CPOE system for inter-organizational and intra-organizational care. Methods: The diffusion of innovation theory was used to understand physicians and nurses attitudes and thoughts about implementation and use of the CPOE system. Two online survey questionnaires were distributed to all physicians and nurses using a CPOE system in county-wide healthcare organizations. The number of complete questionnaires analyzed was 134 from 200 nurses (67.0%) and 176 from 741 physicians (23.8%). Data were analyzed using descriptive-analytical statistical methods. Results: More nurses (56.7%) than physicians (31.3%) stated that the CPOE system introduction had worked well in their clinical setting (P andlt; 0.001). Similarly, more physicians (73.9%) than nurses (50.7%) reported that they found the system not adapted to their specific professional practice (P = andlt; 0.001). Also more physicians (25.0%) than nurses (13.4%) stated that they did want to return to the previous system (P = 0.041). We found that in particular the received relative advantages of the CPOE system were estimated to be significantly (P andlt; 0.001) higher among nurses (39.6%) than physicians (16.5%). However, physicians agreements with the compatibility of the CPOE and with its complexity were significantly higher than the nurses (P andlt; 0.001). Conclusions: Qualifications for CPOE adoption as defined by three attributes of diffusion of innovation theory were not satisfied in the study setting. CPOE systems are introduced as a response to the present limitations in paper-based systems. In consequence, user expectations are often high on their relative advantages as well as on a low level of complexity. Building CPOE systems therefore requires designs that can provide rather important additional advantages, e. g. by preventing prescription errors and ultimately improving patient safety and safety of clinical work. The decision-making process leading to the implementation and use of CPOE systems in healthcare therefore has to be improved. As any change in health service settings usually faces resistance, we emphasize that CPOE system designers and healthcare decision-makers should continually collect users feedback about the systems, while not forgetting that it also is necessary to inform the users about the potential benefits involved.Original Publication:Bahlol Rahimi, Toomas Timpka, Vivian Vimarlund, Srinivas Uppugunduri and Mikael Svensson, Organization-wide adoption of computerized provider order entry systems: a study based on diffusion of innovations theory, 2009, BMC MEDICAL INFORMATICS AND DECISION MAKING, (9), 52, .http://dx.doi.org/10.1186/1472-6947-9-52Licensee: BioMed Centralhttp://www.biomedcentral.com/. On the day of the defence date the original title of this article was "Adoption of computerized provider order entry systems: An organization-wide study based on diffusion of innovations theory"